Truvada, the brand name for a pill containing the two anti-HIV drugs emtricitabine and tenofovir disoproxil fumarate, has been approved by Health Canada for use as part of an HIV prevention regimen, a move that is being praised by physicians and members of the HIV community alike.
Truvada had previously been available in Canada for the purposes of treating people already infected with HIV but now it has gained approval as a pre-exposure prophylaxis (PrEP) for people testing negative for HIV. The HIV and hepatitis C resource centre, CATIE, calls the move “an exciting development.” The change effectively adds Truvada to the suite of prevention measures proposed by Health Canada, which include testing for HIV, screening for sexually transmitted infections (STIs), testing for HIV and the use of condoms.
In the United States, Truvada has been available since 2012 as a PrEP against HIV infection. The U.S. Food and Drug Administration recommends the use of Truvada as a PrEP by a limited group of people: gay or bisexual men who have anal sex without a condom or have been diagnosed with an STI in the last six months, couples where one partner is HIV positive and the other is HIV negative, heterosexual men or women who do not use condoms and have sex with partners of unknown HIV status who are at substantial risk, and those who have injected illicit drugs within the past six months.
In an interview with CBC, Dr. Isaac Bogoch, an infectious disease specialist at Toronto General Hospital, also welcomes Health Canada’s decision. Dr. Bogoch says that he has been administering Truvada as a PrEP drug “off-label” for years, but as the drug is expensive (ranging between $12,000 and $15,000 per year) Health Canada’s move will mean that it can now be covered by private and public medical insurance plans.
Dr. Bogoch says based on his experience the groups likely to benefit from the PrEP use of Truvada would be intravenous drug users, those who engage in unprotected sex and sex workers. He believes that having greater access to the drug is a step in the right direction. “There’s no reason for people who need HIV prevention care to be seen in a big referral hospital. This care should be done in the community and those settings,” Dr. Bogoch says.
Recently, Dr. David Knox, a physician at the Maple Leaf Medical Clinic in Toronto, Ontario, has stated that one of his patients, a 43 year old man who had been using Truvada as a PrEP against HIV for the past 24 months, has contracted HIV, the first recorded case of HIV infection in someone using Truvada on a prophylactic basis. Truvada is thought to be above 99 per cent effective when taken four times a week, but in this case, the man is believed to have been infected by a drug-resistant strain of HIV.
Truvada is taken by both men and women in a PrEP capacity, but a recent study reveals that due to the different ways that the drug accumulates in the body tissues of men and women, women need to take the medication daily whereas men only need twice weekly doses.